The Effect of Using Anchored Wake Time to Derive 24-h Device Measured Circadian Physical Behavior Patterns.

INTRODUCTION: Tailoring physical activity interventions to individual chronotypes and preferences by time of day could promote more effective and sustainable behavior change; however, our understanding of circadian physical behavior patterns is very limited. OBJECTIVE: To characterize and compare 24-h physical behavior patterns expressed relative to clock time (the standard measurement of time-based on a 24-h day) versus wake-up time in a large British cohort age 46. METHODS: Data were analyzed from 4979 participants in the age 46 sweep of the 1970 British Cohort Study who had valid activPAL accelerometer data across ≥4 days. Average steps and upright time (time standing plus time stepping) per 30-min interval were determined for weekdays and weekends, both in clock time and synchronized to individual wake-up times. RESULTS: The mean weekday steps were 9588, and the mean weekend steps were 9354. The mean weekday upright time was 6.6 h, and the mean weekend upright time was 6.4 h. When synchronized to wake-up time, steps peaked 1 h after waking on weekdays and 2.5 h after waking on weekends. Upright time peaked immediately, in the first 30-min window, after waking on both weekdays and weekends. CONCLUSIONS: Aligning accelerometer data to wake-up times revealed distinct peaks in stepping and upright times shortly after waking. Activity built up more gradually across clock time in the mornings, especially on weekends. Synchronizing against wake-up times highlighted the importance of circadian rhythms and personal schedules in understanding population 24-h physical behavior patterns, and this may have important implications for promoting more effective and sustainable behavior change.

Participant and workplace champion experiences of an intervention designed to reduce sitting time in desk-based workers: SMART work & life.

BACKGROUND: A cluster randomised controlled trial demonstrated the effectiveness of the SMART Work & Life (SWAL) behaviour change intervention, with and without a height-adjustable desk, for reducing sitting time in desk-based workers. Staff within organisations volunteered to be trained to facilitate delivery of the SWAL intervention and act as workplace champions. This paper presents the experiences of these champions on the training and intervention delivery, and from participants on their intervention participation. METHODS: Quantitative and qualitative feedback from workplace champions on their training session was collected. Participants provided quantitative feedback via questionnaires at 3 and 12 month follow-up on the intervention strategies (education, group catch ups, sitting less challenges, self-monitoring and prompts, and the height-adjustable desk [SWAL plus desk group only]). Interviews and focus groups were also conducted at 12 month follow-up with workplace champions and participants respectively to gather more detailed feedback. Transcripts were uploaded to NVivo and the constant comparative approach informed the analysis of the interviews and focus groups. RESULTS: Workplace champions rated the training highly with mean scores ranging from 5.3/6 to 5.7/6 for the eight parts. Most participants felt the education increased their awareness of the health consequences of high levels of sitting (SWAL: 90.7%; SWAL plus desk: 88.2%) and motivated them to change their sitting time (SWAL: 77.5%; SWAL plus desk: 85.77%). A high percentage of participants (70%) reported finding the group catch up session helpful and worthwhile. However, focus groups highlighted mixed responses to the group catch-up sessions, sitting less challenges and self-monitoring intervention components. Participants in the SWAL plus desk group felt that having a height-adjustable desk was key in changing their behaviour, with intrinsic as well as time based factors reported as key influences on the height-adjustable desk usage. In both intervention groups, participants reported a range of benefits from the intervention including more energy, less fatigue, an increase in focus, alertness, productivity and concentration as well as less musculoskeletal problems (SWAL plus desk group only). Work-related, interpersonal, personal attributes, physical office environment and physical barriers were identified as barriers when trying to sit less and move more. CONCLUSIONS: Workplace champion and participant feedback on the intervention was largely positive but it is clear that different behaviour change strategies worked for different people indicating that a 'one size fits all' approach may not be appropriate for this type of intervention. The SWAL intervention could be tested in a broader range of organisations following a few minor adaptations based on the champion and participant feedback. TRIAL REGISTRATION: ISCRCTN registry (ISRCTN11618007).

Sensors for Human Physical Behaviour Monitoring.

The understanding and measurement of physical behaviours that occur in everyday life are essential not only for determining their relationship with health, but also for interventions, physical activity monitoring/surveillance of the population and specific groups, drug development, and developing public health guidelines and messages [...].

Beyond the Clinic: Maximum Free-Living Stepping as a Potential Measure of Physical Performance.

Measures of physical performance captured within a clinical setting are commonly used as a surrogate for underlying health or disease risk within an individual. By measuring physical behaviour within a free-living setting, we may be able to better quantify physical performance. In our study, we outline an approach to measure maximum free-living step count using a body-worn sensor as an indicator of physical performance. We then use this approach to characterise the maximum step count over a range of window durations within a population of older adults to identify a preferred duration over which to measure the maximum step count. We found that while almost all individuals (97%) undertook at least one instance of continuous stepping longer than two minutes, a sizeable minority of individuals (31%) had no periods of continuous stepping longer than six minutes. We suggest that the maximum step count measured over a six-minute period may be too sensitive to the adults' lack of opportunity to undertake prolonged periods of stepping, and a two-minute window could provide a more representative measure of physical performance.

Activity, socket fit, comfort and community participation in lower limb prosthesis users: a Cambodian cohort study.

BACKGROUND: After amputation, many people become less active, feel lonely and lose independence. Understanding the factors associated with low physical activity levels and participation could contribute to defining key interventions which can support prosthesis users so they can live a more active and socially included lifestyle. This longitudinal observational study aims to assess relationships between physical activity, community participation, prosthetic fit, comfort and user satisfaction using actimetry, 3D scans and questionnaires in a Cambodian cohort of established lower limb prosthesis users. METHODS: Twenty participants (5F:15M, nine transfemoral, eleven transtibial, 24-60 years old and 3-43 years since amputation) were recruited. They completed a questionnaire which included their demographics, community participation, prosthesis satisfaction and comfort at the start of the study, and between three and six months later. Their prosthetic sockets and residual limbs were 3D scanned at the start and end of the study. Accelerometers were embedded under the cosmesis on the shank of the prosthesis, to collect ten weeks of activity data. RESULTS: Participants averaged 4470 steps/day (743-7315 steps/day), and wore their prosthesis for most waking hours, averaging 13.4 h/day (4.5-17.6 h/day). Self-reported measures of activity and hours of wear correlated with these accelerometer data (Spearman's rho rs = 0.59, and rs = 0.71, respectively). Participants who were more active wore their prosthesis for more hours/day (Pearson r = 0.73) and were more satisfied with socket fit (rs = 0.49). A longer residual limb correlated with better community participation (rs = 0.56) and comfort (rs = 0.56). Self-reported community participation did not correlate with a person's activity level (rs = 0.13), or their prosthesis comfort (rs = 0.19), and there was only weak correlation between how important the activity was to an individual, and how often they participated in it (rs = 0.37). A simple 0-10 scale of overall comfort did not provide enough detail to understand the types and severity of discomfort experienced. CONCLUSION: Associations between perceived and measured activity levels correlated with socket satisfaction in this cohort of people with established lower limb amputations. The small sample size means these correlations should be interpreted with caution, but they indicate variables worthy of further study to understand barriers to community engagement and physical activity for prosthesis users in Cambodia, and potentially in other settings.

A multicenter randomized controlled trial comparing gamification with remote monitoring against standard rehabilitation for patients after arthroscopic shoulder surgery.

BACKGROUND: Gamification has become increasingly popular in rehabilitation and is viewed as a tool to improve patient activation, motivation, and engagement. The aim of this study was to compare the efficacy of validated exergames played through a system using "depth sensor" and bespoke software against standard physiotherapy in patients treated with arthroscopic shoulder surgery. This included the following common conditions: subacromial impingement syndrome, calcific tendinopathy, and rotator cuff tear. METHODS: Following arthroscopic shoulder surgery, patients were randomized into 1 of 2 groups: In the standard rehabilitation group, patients were followed up for 12 weeks after surgery with standard postoperative physiotherapy and underwent electronic measurements of their active range of movement (ROM). In the exergame group, patients followed a postoperative regimen of exergames using the principles of gamification with physiotherapy support. Patients were given an exergame schedule prescribed by their therapist on Medical Interactive Recovery Assistant (MIRA) software (MIRA Rehab, London, UK) paired with a Microsoft Kinect sensor (Microsoft, Redmond, WA, USA). The primary outcome was active ROM objectively measured by MIRA and Kinect. Secondary outcome measures included the Oxford Shoulder Score, the Disabilities of the Arm, Shoulder and Hand score, and the EQ-VAS score at 12 weeks after surgery. RESULTS: A total of 71 patients were recruited to the study. We excluded 7 patients based on intraoperative findings. Thirty-three patients were treated with exergames, and 31 patients underwent conventional physiotherapy. There was no significant difference between the 2 groups in baseline ROM. Postoperatively, there was no significant difference in any of the cardinal planes of movement (forward flexion, P = .64; abduction, P = .33; and external rotation, P = .75). The mean Oxford Shoulder Score improved from 29.25 to 38.2 in the control group (P = .001) and from 27.1 to 35.1 in the trial group (P = .01); there was no significant difference between the groups at 12 weeks (P = .246). The mean Disabilities of the Arm, Shoulder and Hand score improved from 38.13 to 16.98 in the control group (P = .001) and from 42.3 to 22.54 in the trial group (P = .007); there was no significant difference between the 2 groups (P = .328). There was no significant difference in the EQ-VAS score in either group at any time point (P = .5866). CONCLUSION: This randomized controlled trial demonstrates that exergames can be used effectively in the rehabilitation of patients following arthroscopic shoulder surgery. Outcomes, judged by ROM and patient-reported outcome measures, are equivalent to conventional physiotherapy rehabilitation protocols. This health care innovation has the potential to relieve some of the heavy burden placed on physiotherapy departments for "routine" postoperative care in shoulder surgery.

Defining Continuous Walking Events in Free-Living Environments: Mind the Gap.

In free-living environments, continuous walking can be challenging to achieve without encountering interruptions, making it difficult to define a continuous walking event. While limited research has been conducted to define a continuous walking event that accounts for interruptions, no method has considered the intensity change caused by these interruptions, which is crucial for achieving the associated health outcomes. A sample of 24 staff members at the University of Salford were recruited. The participants wore an accelerometer-based device (activPAL™) for seven days continuously and completed an activity diary, to explore a novel methodological approach of combining short interruptions of time between walking events based on an average walking cadence. The definition of moderate-to-vigorous physical activity (MVPA) used was a minimum walking cadence of either 76, 100, or 109 steps/min. The average daily time spent in MVPA increased from 75.2 ± 32.6 min to 86.5 ± 37.4 min using the 76 steps/min, 48.3 ± 29.5 min to 53.0 ± 33.3 min using the 100 steps/min threshold, and 31.4 ± 20.5 min to 33.9 ± 22.6 min using the 109 steps/min threshold; the difference before grouping and after grouping was statistically significant (p < 0.001). This novel method will enable future analyses of the associations between continuous walking and health-related outcomes.

Measuring Foot Abduction Brace Wear Time Using a Single 3-Axis Accelerometer.

The recommended treatment for idiopathic congenital clubfoot deformity involves a series of weekly castings, surgery, and a period of bracing using a foot abduction brace (FAB). Depending on the age of the child, the orthotic should be worn for periods that reduce in duration as the child develops. Compliance is vital to achieve optimal functional outcomes and reduce the likelihood of reoccurrence, deformity, or the need for future surgery. However, compliance is typically monitored by self-reporting, which is time-consuming to implement and lacks accuracy. This study presents a novel method for objectively monitoring FAB wear using a single 3-axis accelerometer. Eleven families mounted an accelerometer on their infant's FAB for up to seven days. Parents were also given a physical diary that was used to record the daily application and removal of the orthotic in line with their treatment. Both methods produced very similar measurements of wear that visually aligned with the movement measured by the accelerometer. Bland Altman plots showed a -0.55-h bias in the diary measurements and the limits of agreement ranging from -2.96 h to 1.96 h. Furthermore, the Cohens Kappa coefficient for the entire dataset was 0.88, showing a very high level of agreement. The method provides an advantage over existing objective monitoring solutions as it can be easily applied to existing FABs, preventing the need for bespoke monitoring devices. The novel method can facilitate increased research into FAB compliance and help enable FAB monitoring in clinical practice.

Estimating changes in physical behavior during lockdowns using accelerometry-based simulations in a large UK cohort.

To contain the recent COVID-19 outbreak, restrictions have been imposed, which has limited outdoor activity. These physical behavior changes can have serious health implications, but there is little objective information quantifying these changes. This study aimed to estimate the change in physical behavior levels during full lockdown conditions using objective data collected from a thigh-worn activity monitor. Data used were from 6492 individuals in the 1970 British Cohort Study, collected between 2016 and 2018. Using walking bout characteristics, days were classified as either "indoor only" (n = 861), "indoor and exercise" (n = 167), and "outdoor active" (n = 31 934). When compared to "outdoor active" days, "indoor only" days had 6590 fewer steps per day (2320 vs 8876, p < 0.001), a longer sedentary time (1.5 h, p < 0.001), longer lying time (1.4 h, p < 0.001) and shorter standing (1.9 h, p < 0.001) and stepping (1.3 h, p < 0.001) times. The "indoor and exercise" days had a smaller number of steps compared to "outdoor active" (7932 vs 8876, p < 0.05). There is a strong relationship between reduced daily stepping, and increased sedentary time, with a range of poor health outcomes. This has important implications for public health policy and messaging during pandemics.

A Machine Learning Classification Model for Monitoring the Daily Physical Behaviour of Lower-Limb Amputees.

There are currently limited data on how prosthetic devices are used to support lower-limb prosthesis users in their free-living environment. Possessing the ability to monitor a patient's physical behaviour while using these devices would enhance our understanding of the impact of different prosthetic products. The current approaches for monitoring human physical behaviour use a single thigh or wrist-worn accelerometer, but in a lower-limb amputee population, we have the unique opportunity to embed a device within the prosthesis, eliminating compliance issues. This study aimed to develop a model capable of accurately classifying postures (sitting, standing, stepping, and lying) by using data from a single shank-worn accelerometer. Free-living posture data were collected from 14 anatomically intact participants and one amputee over three days. A thigh worn activity monitor collected labelled posture data, while a shank worn accelerometer collected 3-axis acceleration data. Postures and the corresponding shank accelerations were extracted in window lengths of 5-180 s and used to train several machine learning classifiers which were assessed by using stratified cross-validation. A random forest classifier with a 15 s window length provided the highest classification accuracy of 93% weighted average F-score and between 88 and 98% classification accuracy across all four posture classes, which is the best performance achieved to date with a shank-worn device. The results of this study show that data from a single shank-worn accelerometer with a machine learning classification model can be used to accurately identify postures that make up an individual's daily physical behaviour. This opens up the possibility of embedding an accelerometer-based activity monitor into the shank component of a prosthesis to capture physical behaviour information in both above and below-knee amputees. The models and software used in this study have been made open source in order to overcome the current restrictions of applying activity monitoring methods to lower-limb prosthesis users.

Are older people putting themselves at risk when using their walking frames?

BACKGROUND: Walking aids are issued to older adults to prevent falls, however, paradoxically their use has been identified as a risk factor for falling. To prevent falls, walking aids must be used in a stable manner, but it remains unknown to what extent associated clinical guidance is adhered to at home, and whether following guidance facilitates a stable walking pattern. It was the aim of this study to investigate adherence to guidance on walking frame use, and to quantify user stability whilst using walking frames. Additionally, we explored the views of users and healthcare professionals on walking aid use, and regarding the instrumented walking frames ('Smart Walkers') utilized in this study. METHODS: This observational study used Smart Walkers and pressure-sensing insoles to investigate usage patterns of 17 older people in their home environment; corresponding video captured contextual information. Additionally, stability when following, or not, clinical guidance was quantified for a subset of users during walking in an Activities of Daily Living Flat and in a gait laboratory. Two focus groups (users, healthcare professionals) shared their experiences with walking aids and provided feedback on the Smart Walkers. RESULTS: Incorrect use was observed for 16% of single support periods and for 29% of dual support periods, and was associated with environmental constraints and a specific frame design feature. Incorrect use was associated with reduced stability. Participants and healthcare professionals perceived the Smart Walker technology positively. CONCLUSIONS: Clinical guidance cannot easily be adhered to and self-selected strategies reduce stability, hence are placing the user at risk. Current guidance needs to be improved to address environmental constraints whilst facilitating stable walking. The research is highly relevant considering the rising number of walking aid users, their increased falls-risk, and the costs of falls.

Technology for monitoring everyday prosthesis use: a systematic review.

BACKGROUND: Understanding how prostheses are used in everyday life is central to the design, provision and evaluation of prosthetic devices and associated services. This paper reviews the scientific literature on methodologies and technologies that have been used to assess the daily use of both upper- and lower-limb prostheses. It discusses the types of studies that have been undertaken, the technologies used to monitor physical activity, the benefits of monitoring daily living and the barriers to long-term monitoring, with particular focus on low-resource settings. METHODS: A systematic literature search was conducted in PubMed, Web of Science, Scopus, CINAHL and EMBASE of studies that monitored the activity of prosthesis users during daily-living. RESULTS: Sixty lower-limb studies and 9 upper-limb studies were identified for inclusion in the review. The first studies in the lower-limb field date from the 1990s and the number has increased steadily since the early 2000s. In contrast, the studies in the upper-limb field have only begun to emerge over the past few years. The early lower-limb studies focused on the development or validation of actimeters, algorithms and/or scores for activity classification. However, most of the recent lower-limb studies used activity monitoring to compare prosthetic components. The lower-limb studies mainly used step-counts as their only measure of activity, focusing on the amount of activity, not the type and quality of movements. In comparison, the small number of upper-limb studies were fairly evenly spread between development of algorithms, comparison of everyday activity to clinical scores, and comparison of different prosthesis user populations. Most upper-limb papers reported the degree of symmetry in activity levels between the arm with the prosthesis and the intact arm. CONCLUSIONS: Activity monitoring technology used in conjunction with clinical scores and user feedback, offers significant insights into how prostheses are used and whether they meet the user's requirements. However, the cost, limited battery-life and lack of availability in many countries mean that using sensors to understand the daily use of prostheses and the types of activity being performed has not yet become a feasible standard clinical practice. This review provides recommendations for the research and clinical communities to advance this area for the benefit of prosthesis users.

Exploring occupational standing activities using accelerometer-based activity monitoring.

Prolonged standing at work is required by an estimated 60% of the employed population and is associated with a high prevalence of musculoskeletal disorders. 'Standing' is expected to encompass a range of activities of varying intensity. This study aimed to define a range of 'standing' work-based activities; and objectively explore differences between 'standing' occupations. The following movements were defined using a triaxial accelerometer (ActivPAL) through recordings of known movements (n = 11): static standing, weight-shifting, shuffling, walking and sitting. Movements over a working day were defined for chefs (n = 10), veterinary surgeons (n = 7) and office workers (n = 9). Despite veterinary surgeons and chefs spending a similar time in an upright posture, veterinary surgeons spent 62% of this time standing statically whereas chefs split their time between all the movements. Overall, this study provides the first attempt to define 'standing' activities, allowing the differentiation of activities between occupations spending similar periods of time upright. Practitioner Summary: This study identified a range of work-based 'standing' activities of varying intensity. Differences in activity were recorded between two occupations spending a similar time in an upright posture (veterinary surgeons and chefs). A broader definition of standing activities could be important when considering factors related to musculoskeletal disorders at work.

A three arm cluster randomised controlled trial to test the effectiveness and cost-effectiveness of the SMART Work & Life intervention for reducing daily sitting time in office workers: study protocol.

BACKGROUND: Office-based workers typically spend 70-85% of working hours, and a large proportion of leisure time, sitting. High levels of sitting have been linked to poor health. There is a need for fully powered randomised controlled trials (RCTs) with long-term follow-up to test the effectiveness of interventions to reduce sitting. This paper describes the methodology of a three-arm cluster RCT designed to determine the effectiveness and cost-effectiveness of the SMART Work & Life intervention, delivered with and without a height-adjustable desk, for reducing daily sitting. METHODS/DESIGN: A three-arm cluster RCT of 33 clusters (660 council workers) will be conducted in three areas in England (Leicester; Manchester; Liverpool). Office groups (clusters) will be randomised to the SMART Work & Life intervention delivered with (group 1) or without (group 2) a height-adjustable desk or a control group (group 3). SMART Work & Life includes organisational (e.g., management buy-in, provision/support for standing meetings), environmental (e.g., relocating waste bins, printers), and group/individual (education, action planning, goal setting, addressing barriers, coaching, self-monitoring, social support) level behaviour change strategies, with strategies driven by workplace champions. Baseline, 3, 12 and 24 month measures will be taken. PRIMARY OUTCOME: Objectively measured daily sitting time (activPAL3). SECONDARY OUTCOMES: objectively measured sitting, standing, stepping, prolonged sitting and moderate-to-vigorous physical activity time and number of steps at work and daily; objectively measured sleep (wrist accelerometry). Adiposity, blood pressure, fasting glucose, glycated haemoglobin, cholesterol (total, HDL, LDL) and triglycerides will be assessed from capillary blood samples. Questionnaires will examine dietary intake, fatigue, musculoskeletal issues, job performance and satisfaction, work engagement, occupational and general fatigue, stress, presenteeism, anxiety and depression and sickness absence (organisational records). Quality of life and resources used (e.g. GP visits, outpatient attendances) will also be assessed. We will conduct a full process evaluation and cost-effectiveness analysis. DISCUSSION: The results of this RCT will 1) help to understand how effective an important simple, yet relatively expensive environmental change is for reducing sitting, 2) provide evidence on changing behaviour across all waking hours, and 3) provide evidence for policy guidelines around population and workplace health and well-being. TRIAL REGISTRATION: ISRCTN11618007 . Registered on 21 January 2018.

Methods for the Real-World Evaluation of Fall Detection Technology: A Scoping Review.

Falls in older adults present a major growing healthcare challenge and reliable detection of falls is crucial to minimise their consequences. The majority of development and testing has used laboratory simulations. As simulations do not cover the wide range of real-world scenarios performance is poor when retested using real-world data. There has been a move from the use of simulated falls towards the use of real-world data. This review aims to assess the current methods for real-world evaluation of fall detection systems, identify their limitations and propose improved robust methods of evaluation. Twenty-two articles met the inclusion criteria and were assessed with regard to the composition of the datasets, data processing methods and the measures of performance. Real-world tests of fall detection technology are inherently challenging and it is clear the field is in its infancy. Most studies used small datasets and studies differed on how to quantify the ability to avoid false alarms and how to identify non-falls, a concept which is virtually impossible to define and standardise. To increase robustness and make results comparable, larger standardised datasets are needed containing data from a range of participant groups. Measures that depend on the definition and identification of non-falls should be avoided. Sensitivity, precision and F-measure emerged as the most suitable robust measures for evaluating the real-world performance of fall detection systems.

The influence of dog ownership on objective measures of free-living physical activity and sedentary behaviour in community-dwelling older adults: a longitudinal case-controlled study.

BACKGROUND: There is some evidence to suggest that dog ownership may improve physical activity (PA) among older adults, but to date, studies examining this, have either depended on self-report or incomplete datasets due to the type of activity monitor used to record physical activity. Additionally, the effect of dog ownership on sedentary behaviour (SB) has not been explored. The aim of the current study was to address these issues by using activPAL monitors to evaluate the influence of dog ownership on health enhancing PA and SB in a longitudinal study of independently-mobile, community-dwelling older adults. METHODS: Study participants (43 pairs of dog owners and non-dog owners, matched on a range of demographic variables) wore an activPAL monitor continuously for three, one-week data collection periods over the course of a year. Participants also reported information about their own and their dog demographics, caring responsibilities, and completed a diary of wake times. Diary data was used to isolate waking times, and outcome measures of time spent walking, time spent walking at a moderate cadence (>100 steps/min), time spent standing, time spent sitting, number of sitting events (continuous periods of sitting), and the number of and of time spent sitting in prolonged events (>30 min). For each measure, a linear mixed effects model with dog ownership as a fixed effect, and a random effects structure of measurement point nested in participant nested in pair was used to assess the effect of dog ownership. RESULTS: Owning a dog indicated a large, potentially health improving, average effect of 22 min additional time spent walking, 95%CI (12, 34), and 2760 additional steps per day, 95%CI (1667, 3991), with this additional walking undertaken at a moderate intensity cadence. Dog owners had significantly fewer sitting events. However, there were no significant differences between the groups for either the total time spent sitting, or the number or duration of prolonged sedentary events. CONCLUSIONS: The scale of the influence of dog ownership on PA found in this study, indicates that future research regarding PA in older adults should assess and report dog ownership and/or dog walking status.

Total Hip Arthroplasty Improves Pain and Function but Not Physical Activity.

BACKGROUND: People with hip osteoarthritis are likely to limit physical activity (PA) engagement due to pain and lack of function. Total hip arthroplasty (THA) reduces pain and improves function, potentially allowing increased PA. PA of THA patients was quantified to 12 months postoperation. The hypothesis was that postoperatively levels of PA would increase. METHODS: PA of 30 THA patients (67 ± 7 years) was objectively measured preoperatively and 3 and 12 months postoperation. Harris Hip Score (HHS), Oxford Hip Score (OHS), and 6-minute walk test (6MWT) were recorded. Mixed linear modelling was used to examine relationships of outcomes with time, baseline body mass index (BMI), age, gender, and baseline HHS. RESULTS: Time was not a significant factor in predicting volume measures of PA, including sit-to-stand transitions, upright time, and steps. Notably, baseline BMI was a significant predictor of upright time, steps, largest number of steps in an upright bout, HHS, and 6MWT. Baseline HHS helped predict longest upright bout, cadence of walking bouts longer than 60 seconds, and OHS. The significant effect of participant as a random intercept in the model for PA outcomes suggested habituation from presurgery to postsurgery. CONCLUSION: Volume measures of PA did not change from presurgery to 12 months postsurgery despite improvement in HHS, OHS, and 6MWT. Baseline BMI was a more important predictor of upright activity and stepping than time. Preoperative and postoperative PA promotion could be used to modify apparently habitual low levels of PA to enable full health benefits of THA to be gained.

The long-term effect of being treated in a geriatric ward compared to an orthopaedic ward on six measures of free-living physical behavior 4 and 12 months after a hip fracture - a randomised controlled trial.

BACKGROUND: This study is part of the Trondheim Hip Fracture Trial, where we compared free-living physical behavior in daily life 4 and 12 months following hip surgery for patients managed with comprehensive geriatric care (CGC) in a geriatric ward with those managed with orthopedic care (OC) in an orthopedic ward. METHODS: This is a single centre, prospective, randomized controlled trial. 397 hip fracture patients were randomized to CGC (n = 199) or OC (n = 198) in the Emergency Department with follow-up assessments performed four and 12 months post-surgery. Outcomes were mean upright time, number and length of upright events recorded continuously for four days at four and 12 months post-surgery by an accelerometer-based activity monitor. Missing data were handled by multiple imputation and group differences assessed by linear regression with adjustments for gender, age and fracture type. RESULTS: There were no group differences in participants' pre-fracture characteristics. Estimated group difference in favor of CGC in upright time at 4 months was 34.6 min (17.4 %, CI 9.6 to 59.6, p = .007) and at 12 months, 27.7 min (13.9 %, CI 3.5 to 51.8, p = .025). Average and maximum length of upright events was longer in the CGC (p's < .042). No group difference was found for number of upright events (p's > .452). CONCLUSION: Participants treated with CGC during the hospital stay improved free-living physical behavior more than those treated with OC both 4 and 12 months after surgery, with more time and longer periods spent in upright. Results support findings from the same study for functional outcomes, and demonstrate that CGC impacts daily life as long as one year after surgery. TRIALS REGISTRATION: ClinicalTrials.gov, NCT00667914 , April 18, 2008.

Walking Behaviour of Individuals with Intermittent Claudication Compared to Matched Controls in Different Locations: An Exploratory Study.

Individuals with intermittent claudication (IC) are less physically active than their peers, but how this varies with location is unclear. Individuals with IC and matched controls [sex, age ±5 years, home < 5 miles] wore an activity monitor (activPAL) and carried a GPS device (AMOD-AGL3080) for 7 days. GPS data categorised walking events as occurring at home (<=50 m from home co-ordinates) or away from home, and indoors (signal to noise ratio <= 212 dB) or outdoors. Number of walking events, walking duration, steps and cadence were compared between groups and each location pair using mixed model ANOVAs. In addition, the locus of activity (distance from home) at which walking was conducted was compared between groups. Participants (n = 56) were mostly male (64%) and aged 54-89 years. Individuals with IC spent significantly less time walking and took fewer steps than their matched controls at all locations, including at home. Participants spent more time and took more steps away from home than at home, but were similar when walking indoors and outdoors. The locus of activity was significantly smaller for individuals with IC, suggesting that it is not just physical capacity that influences walking behaviour, and other factors (e.g., social isolation) may play a role.